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Clinical Affordability Consultant - WA, OR, ID - Hybrid




Tacoma, Washington, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Under minimal supervision, Drive clinical relationships and engagement with physicians practices, members and potentially pharmacies while partnering internally with RQE, HCE, medical directors, contracting etc) with the goal of improving health, utilization, cost, quality and practice performance while reducing medical cost. The Clinical Affordability Consultant should have solid analytic and organizational/project management skills as well as clinical experience to influence and drive towards quality and cost effective care. This position will work in close collaboration with the quality and patient experience value lanes to support risk based provider partners and work to achieve practice transformation.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Identify medical cost affordability opportunities
  • Develop, prioritize, manage, and execute affordability initiatives, owning end to end process
  • Leverage local market, national, and functional (network, clinical, payment integrity, etc.) subject matter experts to optimize the value of affordability initiatives across the organization
  • Use data to analyze key cost, utilization and quality data and interpret the results to asses the performance of the practice
  • Identify and resolve technical, operational and organizational problems outside own team
  • Predict emerging customer needs and develop innovative solutions to meet them
  • Participate and drive efficient patient and practice improvement meetings with the practice to monitor, engage, present, discuss and strategize on a practice transformation action plan
  • Ability to interpret large and varying data sets
  • Experience with health insurance, risk bearing contracts, med advantage, high cost, high risk, high utilization populations
  • Experience building and effectively maintaining relationships with practice leadership and key clinic influencers
  • Ability to facilitate efficient effective practice improvement meeting to network providers to lead discussions on practice improvement, cost strategies, appropriate alternative placements or care
  • Experience in analyzing data to drive strategic discussions based on performance analysis for improvement that includes specific outcomes and metrics to monitor progress towards a goal
  • Proven track record collaborating with internal matrix partners to identify organizational and structural challenges that may be hindering achievement of desired program outcomes
  • Experience assisting practices in creating workflows to optimize care delivery, introduce best practice improvements and evaluate outcomes
  • Educate and deploy technology tool into practice workflows to support practice transformation
  • Clinical experience with patient population, health disparity, SDOH to assist clinic(s) in developing solutions to raise practice and patient experience

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • RN, BSN
  • Current unrestricted Nursing license
  • 5+ years of broad-based clinical experience
  • Experience implementing Clinical Transformation/Value Based initiatives designed to help provider groups achieve large scale health transformation goals
  • Experience preparing and presenting information to clinical and executive level leadership
  • Current driver’s license
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualification:

  • Master's Degree

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.